Tackling inequalities in health and care — the NHS Patient and Carer Race Equality Framework

Care Quality Commission
3 min readMar 4, 2024

In this blog Chris Dzikiti, Director for Mental Health, discusses NHS England’s Patient and Carer Race Equality Framework and it aims to tackle racial inequalities and epistemic injustice faced by people from ethnic minority groups.

Photo by Volodymyr Hryshchenko on Unsplash

There is a fundamental link between human rights and delivering safe, good quality care. We know this, yet the struggle to address racial inequalities and inequity in mental health services continues. People from Black and Black British groups are over three and a half times more likely than people in white ethnic groups to be detained under the Mental Health Act and have higher rates of being restrained in inpatient units. They are also twice as likely to die while in custody, and Black or Black British people have longer periods of detention and more repeated admissions, and are more likely to be made subject to police holding powers under the Mental Health Act.

This is all despite many attempts at creating an equal system with culturally appropriate care and treatment available to everyone, regardless of their background. We have to address the racial inequalities and epistemic injustice faced by people from ethnic minority groups when detained under the Mental Health Act, and one of the core ambitions of our 2021 strategy was to tackle inequalities: ‘Tackling inequalities in health and care: Pushing for equality of access, experiences and outcomes from health and social care services’. I believe that the roll out of the NHS Patient and Carer Race Equality Framework (PCREF) will begin to do this.

PCREF is an incredibly important part of advancing rights-respecting care. Launched in October by NHS England, PCREF is the first anti-racism framework for mental health trusts and mental health service providers which sets out to improve access, experience and outcomes for people from ethnic minority groups. The framework has been coproduced with experts by experience, carers, and PCREF pilot trusts and early adopter sites who have partnered with ethnic led voluntary sector organisations. It is vital that PCREF sits firmly within our new single assessment framework and we have worked closely with NHS England to make sure that this is possible.

By March 2025 all NHS-funded mental health trusts and services will be required by law to have implemented the framework. We will encourage and support services to embed the approach through our regulatory activity. We have produced initial guidance and learning for our regulatory colleagues.

Initially, we will explore awareness of PCREF and its purpose, as well as providers’ arrangements and plans to develop and implement PCREF in their organisation. We also want to take the opportunity where we can to share learning about the practical development of PCREF within trusts.

In a recent blog, Lucy Wilkinson, CQC’s Interim Head of equality, health inequalities and human rights, talked about our refreshed human rights approach. In this approach we are clear that “people whose voices are less heard, valued and understood are the people who need protecting the most” — this is key to how we should all approach human rights and care. In our new assessment framework, we have built human rights principles into the quality statements and will use all of our available regulatory levers to advance rights-respecting care. Lucy also discussed our involvement in national initiatives developing evidence-based approaches that help services deliver rights-respecting care. This includes PCREF.

There are many causes of poor experiences of mental health care for people from ethnically and culturally diverse communities, including a lack of cultural safety, stigma, lack of trust, and discriminatory behaviours. I believe we have a real opportunity now to address these inequalities. At the heart of this work is the desire and our deep commitment to improve the experiences of people who are using services, treating everyone with the dignity and respect they deserve.

Blog author Chris Dzikiti, Director for Mental Health at CQC



Care Quality Commission

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.